Identifying Themes for an Initial Beta Version of a Mobile Health App for Latino and Native Hawaiian/Pacific Islander Communities: Co-Design and Community-Based Participatory Research in a Code to Community Study

Introduction

Adopting innovations has become increasingly important, driven by postpandemic growth in the use of technology for wellness and health care [Qiu Y, Huang H, Gai J, De Leo G. The effects of the COVID-19 pandemic on age-based disparities in digital health technology use: secondary analysis of the 2017-2022 Health Information National Trends Survey. J Med Internet Res. Dec 04, 2024;26:e65541. [FREE Full text] [CrossRef] [Medline]1]. New social norms, attitudes, and behavior patterns impact health and participation in health behavior interventions. Latino and Native Hawaiian/Pacific Islander (NHPI) populations, among the fastest-growing minority US populations [Improved race and ethnicity measures reveal United States population is much more multiracial. United States Census Bureau. 2021. URL: https:/​/www.​census.gov/​library/​stories/​2021/​08/​improved-race-ethnicity-measures-reveal-united-states-population-much-more-multiracial.​html [accessed 2025-05-29] 2], experience exacerbated health disparities. Heart disease, cancer, and diabetes are leading causes of death in these populations, and both have high rates of obesity [Minority population profiles. Office of Minority Health. URL: https://minorityhealth.hhs.gov/minority-population-profiles [accessed 2025-05-29] 3]. Latino and NHPI populations are less likely to receive mental health services [Minority population profiles. Office of Minority Health. URL: https://minorityhealth.hhs.gov/minority-population-profiles [accessed 2025-05-29] 3], even though stigmas have decreased [Pescosolido BA, Halpern-Manners A, Luo L, Perry B. Trends in public stigma of mental illness in the US, 1996-2018. JAMA Netw Open. Dec 01, 2021;4(12):e2140202. [FREE Full text] [CrossRef] [Medline]4].

Formative research is essential to informing culturally tailored and innovative strategies to reduce health disparities and address community priorities. Preliminary analysis of PIC Health (Pacific Islander Community Health/Elige Salud) study data will inform the first phase of developing a beta version of a mobile health (mHealth) app. This will enable collection of detailed feedback on the app’s acceptability, feasibility, and general design from community leaders, members, and other stakeholders. This study aims to identify community priorities and general themes to build the mHealth beta app.

Methods

Through a co-design and community-based participatory research (CBPR) approach, we partnered with Latino and NHPI communities to conduct 12 key informant interviews, 4 focus groups, and 2 community stakeholder meetings, divided equally across the groups. Participants were recruited by convenience sampling at cultural organizations, clubs, and community events. Latino-identifying participants (8 female, 3 male) were primarily of Mexican origin and NHPI participants (8 female, 7 male) included Samoan, Native Hawaiian, and Chamorro people. All participants resided in North County, San Diego, and were older than 18 years (range: 18-69 years).

Key informant interviews and focus groups were recorded, transcribed, and uploaded into ATLAS.ti for qualitative coding and analysis. At least two research team members coded, verified, and extracted themes from the transcripts, which were analyzed using directed content analysis to identify and categorize meaningful information about participants’ opinions, perceptions, and experiences [Hsieh H, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. Nov 2005;15(9):1277-1288. [CrossRef] [Medline]5]. Coding strategies included the selection of responses for emergent themes and a priori categories [Ryan GW, Bernard HR. Techniques to identify themes. Field Methods. Feb 01, 2003;15(1):85-109. [CrossRef]6]. Emergent themes were verified through team discussions and the coding framework. Once themes were identified, the research team worked with a senior software engineer and computer science students to design a progressive web application (PWA; a website that behaves like a mobile app) as an initial beta mHealth app. The research was deemed exempt by the California State University, San Marcos institutional review board, with informed consent waived (1858351). Data were anonymized and participants received US $30 gift cards for interviews and US $20 gift cards for focus groups.

Results

Across all participants, three major themes were identified for community health priorities: (1) mental health, (2) access to resources and health education, and (3) attention to chronic disease prevention (eg, diabetes, cancer, heart disease). Latino participants emphasized access to health resources and NHPI participants emphasized mental health. In response to questions about improving intervention success, both communities identified two major themes: (1) social and cultural connectedness and (2) attention to generational approaches (Table 1). For the latter, Latino participants identified a need for intergenerational strategies (across generations), while some NHPI participants mentioned multigenerational strategies (tailoring to specific generations).

Based on community stakeholder meetings, theme prioritization, and adaptability to different cultures, the beta mHealth app was created in the PWA format. Figure 1 depicts the alignment between key themes and their corresponding app components.

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Discussion

Our research identified major themes from qualitative data that translated into components of an initial mHealth app beta designed for the Latino and NHPI communities. The themes identified in the preliminary analysis for community health priorities include mental health, access to resources, and chronic disease prevention. Themes surrounding intervention success include social and cultural connectedness and generational approaches. Many themes overlap between the Latino and NHPI communities, but cultural details and tailoring should differ.

The initial beta incorporates both communities; however, future work may lead to the need for separate mHealth apps or other advanced strategies to tailor information in real time, such as the use of artificial intelligence to populate appropriate resources, although challenges related to artificial intelligence in mHealth must be addressed [Deniz-Garcia A, Fabelo H, Rodriguez-Almeida AJ, Zamora-Zamorano G, Castro-Fernandez M, Alberiche Ruano MDP, et al. Quality, usability, and effectiveness of mHealth apps and the role of artificial intelligence: current scenario and challenges. J Med Internet Res. May 04, 2023;25:e44030. [FREE Full text] [CrossRef] [Medline]7]. The next phase of app development will include gathering additional community insights on usability, acceptability, and design improvements through a mixed methods approach. Feedback and ongoing co-design collaboration in this next phase will result in a final mHealth app for beta testing. Overall, to address health equity, co-design and CBPR approaches with the communities who benefit are essential for adoption of new technologies and greater mHealth intervention success.